1. VR Disorders; Clinical presentation, classification and RD Ayesha S Abdullah 21.12.2012

2. Learning outcomes By the end of the lecture the students would be able to:  Identify the symptoms of VR disorders and correlate them with underlying pathophysiological mechanisms.  Classify VR disorders into broad categories.  Describe the clinical presentation and epidemiology of RD  Correlate the mechanism of retinal detachment with the development (RD) of the eye  Classify RD  Identify major causes of RD  Outline the principles of management

3. Common symptoms of VR diseases  Blurred vision/decreased vision  Distorted vision ( metamorphopsia)  Difficulty in near work  difficulty in recognizing faces  Something blocking central vision ( positive scotoma)  Minified image/micoropsia-spreading apart of foveal cones  Magnification of images/ macropsia-crowding of cones at fovea

4.  Problems with colour vision  Difficulty in dark adaptation  Field loss  Seeing sparkilign bright lights/ photopsia  Seeing webs/ black dots -floaters  Difficulty in night vision-nyctalopia  Difficulty in day vision-hemeralopia

5. Common signs  Decreased visual acuity  RAPD  Opacities in the vitreous  Liquified vitreous gel  Cells in the vitreous  Signs in the retina specific to the specific disease entity  Self-reported Amsler grid  Nystagmus

6. Classification of VR disorders  Diseases of the vitreous  Retinal Detachment  Vascular retinopahties  Vitreoretinal degenerations  Inflammatory & infective disorders  Tumours of the retina

9. DEVELOPMENT OF THE EYE

10. What is RD? Separation of the sensory retina from the retinal pigment epithelium by the subretinal fluid

11.  Rhegmatogenous RD  Non- rhegmatogenous –Exudative RD –Tractional TYPES

12. RRD-some anatomical considerations  Vitreo-retinal adhesions disc, ora, blood vessels & at fovea  Potential subretinal space

14. RRD RD secondary to a break in the retina

15. Causes & risk factors  In 15% of cases with Posterior vitreous detachment (PVD) a tear develops in the retina  60% of tears develop in peripheral retina with retinal degenerations like Lattice degeneration  40% of the RD occur in myopic eyes; the higher the error the greater the risk  Post- Cataract surgery (pseudophakia) ; especially in eyes with retinal degeneration and myopia can develop retinal tears and RRD

16. Clinical presentation –symptoms  Flashes of light  Floaters  Visual loss  Visual field loss  Usually an acute event  History of predisposing factors, myopia, cataract surgery, trauma etc

17. Field loss

18. Clinical examination –signs Visual acuity Anterior segment examination Pupils, (RAPD) Posterior segment examination Vitreous- tobacco dust Retinal signs IOP ( may be low)

19. Clinical examination –signs Direct ophthalmoscopy

20. Indirect Ophthalmoscopy

21. Normal fundus

22. Rtinal detachment with tear

23. RD

24. RD with giant tear

25. Tractional retina detachment

26. Principles of management  External temponade/ scleral buckling –Seal the break –Create a buckle –Drain the SRF-if required  Internal temponade/

27. Management

31. Prophylaxis of RRD  Photocoagulation of the risky lesions with laser  So patients with risk facotrs should be referred for treatment/ consideration of the treatment

32. Let us Summarize